foundation. and dr. rick warren, pastor of saddleback church. to each of you, thank you for coming. you have an incredibly busy schedule. you made time to talk about causes near and dear to your heart. i will make a brief opening statement to subcommittee members. thank you for showing up. to senator leahy, it's been a pleasure working with you and tim in the minority and the majority. as politics change in this country, senator leahy and i are going to make sure the commitment of this does not change. at the end of the day, i've tried, along with senator leahy, to shine a light on what the 150 count does for the united states and the world. it's 1% of our budget. here's what i would suggest to other members of the body. find an account anywhere throughout the budget that gets a better rate of return than the 150 account. so 1% of the budget is 50 something billion dollars when you add it all up. that

includes all the funding for the state department and our embassies and consulate, aid to israel and other nations. a small portion of it goes to fighting a.i.d.s. and malaria, tuberculosis, and other diseases. what i want the american taxpayer to know is that from my point of view being a conservative republican from south carolina, i've never seen a better return on investment. the private sector and the federal government and other international organizations and other governments have been collaborating for well over a decade to take the fight to a.i.d.s., and we're winning and a.i.d.s. is losing. at the end of the day, the scourge is being put in a box but growing in some areas of africa for reasons we must address. in terms of future commitment of money, now is not the time to back off. we're literally inside the ten yard line when it comes to some of these

diseases like a.i.d.s. and malaria, and there are thousands, if not millions, of young people alive today because of america's intervention and the taxpayers' generosity. it's a national security effort in my view to stabilize developing parts of the world so rampant diseases like a.i.d.s., malaria, and tuberculosis can be contained and does not create instability in regions that are already unstable. from an economic point of view, we're creating a customer base where american companies one day can do business with millions of people on a continent that i've come to love that have an affinity for the american people and our way of life. and america's at her best, i believe, when she is doing things that are right. even though we have economic challenges here at home, compared to most we're incredibly rich. but our richness is not in our bank

account. i think it is in our attitude and the way the american people engage the world. if i had to give one example to someone from far away to explain america, i would use this account. this account represents the best of the american people. it's transparent, it is well managed, it is saving lives, and changing the world. having said that, this count is at risk. sequestration budget cuts, if fully enacted, will devastate the ability of this account and others to fulfill its promise. we're literally inside the ten yard line, and the budget cuts that are coming under sequestration will destroy our ability to make progress, and we'll lose many of the gains we have achieved over time. when you're $18 trillion in debt, you need to

evaluate your spending. here's what i can say. this account is not why we're in debt. this account makes us richer. this account, i believe, is the smartest use of federal dollars of any place within the federal government. it is my commitment working with my democrat and republican colleagues that we not abandon this account at a time when we're so close to achieving the purposes of this account, which is to change the world in a positive fashion. with that i'd recognize senator leahy. >> thank you, mr. chairman. you and i have worked together on this committee for so many years. we go back and forth. sometimes you're chairman, sometimes i'm chairman. the thing is, we come up with a bill almost always where we are in total agreement on it, and that's why it

passes. this is an issue that should not get involved in partisan politics. i can't think of these kind of programs we fund that have stronger support than global health. we support investments to combat diseases. i know last night in our discussion, sir elton and pastor warren, we talked about a lot of these diseases that could be prevented or treated or cured for just a few dollars. if it happened to any one of us, we could come up with whatever amount of money it was. but we're talking about countries where that money is not there. very few americans suffer from malaria, polio dengue fever or blindness. can you imagine if they did? you'd have people lined out here saying, let's do something about it. when you're in the wealthiest country on earth, we

have some moral responsibilities. this goes beyond political or economic. if you had this kind of great wealth, you have some moral responsibilities. especially when these diseases afflict millions of people, often children, in countries that have woefully inadequate health services. hiv/a.i.d.s. was identified 33 years ago, but a.i.d.s. and tuberculosis continue to be a serious problem not only worldwide but here in the united states. we can do better. but the rates of infection here in this country pale compared to many other countries. subis a har ran africa, southeast asia. now the chairman has rightly pointed out budget restraints we have, but that does not mean we suddenly have no money. we have a lot of money to spend as a

country. and let's pick where we go. we just want to make sure we use our best resources. the ebola catastrophe, that shows how vulnerable we are as bill gates and others have warned. ebola was a relatively easy disease to detect and contain compared to one that's infectious before a person experiences symptoms. so the it's not a question whether such a virus will occur but when and where. if we don't invest a relatively modest sum necessary to train health workers in countries where such a pandemic can originate, we're going to pay more in the hundreds of thousands, even millions of lives lost and dollars spent. these are things that you certainly work on all the time. our chairman are also supposed to be in defense appropriations but we wanted to be here. we

all work -- every one of you have worked so hard on these issues. every one of you could find much easier things to tackle. i applaud you all. sir elton, we've known each other for a number of years. you can sit back and just relax. instead, you're out pushing us all the time. i don't want to say anything about pastor warren going after us on a moral issue, but the good pastor has spoken to me about where our conscience should be on more than one occasion. and that's important. but doctors, the expertise you bring, we need it. so i will hush up. i want to hear from these people. but i'm glad you're doing this. >> thank you. thank you for being a good partner here.

madam ambassador, lead us off. >> thank you, chairman graham and ranking member leahy and distinguished members of the subcommittee. i'm honored to appear before you, specifically this subcommittee today, which has provided visionary leadership of the united states president's emergency plan for a.i.d.s. relief since 2003. millions of men, women, and children are alive today because of the compassion and bipartisan commitment of congress. the leadership of president george w. bush and president barack obama and the true generosity of the american people. as you've seen first hand and as the chairman mentioned, it's not only a transformative global health program but is an outstanding expression of american diplomacy. i'm privileged to be joined today by three great leaders for the response. ambassador mark dybul, whose stewardship has been

extraordinary. pastor rick warren a voice of compassion for those affected by the epidemic. and sir elton john, a powerful advocate for people living with hiv/a.i.d.s. for decades. we have changed the very trajectory of the hiv/a.i.d.s. pandemic. it's offered hope, healing, and the possibility of prosperity in the place of sickness, suffering, and death. today, because of the group, 7.7 million men, women, and children are receiving life-saving children, and more than a million babies have been born hiv free. 6.7 million voluntary medical male circumcisions have been performed. success, as mentioned by the chairman, is within our collective grasp. if we all focus, accelerate, and sustain our efforts. our work, as mentioned, is far from done.

every week, nearly 40,000 people are infected with hiv 7,000 of them young women. with the youth bulge in subsaharan africa, many women are entering the window of the most susceptibleility to hiv/a.i.d.s. infection. we have to work diligently right now to get and stay ahead of this epidemic. if we don't act now, there will be an estimated 28 million new hiv infections by 2030. more infections than any global resources can support. actions taken over the next five years will be critical. coordinated efforts could reduce the number of hiv infections to under $200,000 per year by 2030. as compared to our current trajectory,

which is unthinkable, of 2.5 million new infections per year. so pepfar is pivoting. we're utilizing a very granular, yet transparent data-driven approach to target evidence-based interventions to the highest burden populations and geographic areas for maximum impact of every u.s. dollar. making this pivot is not an easy thing. but it is the right thing. and it will prevent new infections and lead to control of the epidemic. earlier this year, we launched a sustainability index to provide an annual snapshot of the elements central to sustaining and controlling this epidemic, including the critical contributions partner countries are making towards their national response. pepfar leverages the expertise of the whole of the united states government, civil society, faith-based organization, and other partners, including the private sector, to address the most glaring gaps in treatment and prevention. the accelerating children treatment

program is a $200 million partnership with the children's investment fund foundation to reach and treat 300,000 additional children living with hiv/a.i.d.s. by the end of 2016. d.r.e.a.m. is a $210 million partnership with the bill and melinda gates foundation and the nike foundation to prevent hiv infection in adolescent girls and young women. finally, we cannot control the epidemic without putting an end to the stigma and discrimination that force people living with and at risk for hiv/a.i.d.s. to the very margins. all people need accesses to services, including key populations. at this critical time in the a.i.d.s. response, we know what needs to be done, and we have the tools

to do it. the continued leadership of the united states is vital to ensuring we achieve an a.i.d.s.-free generation because the alternative is unthinkable. chairman graham ranking member leahy, members of the subcommittee, the uncharted terrain we're entering will test our resolve but i am confident that we'll reach our destination. the ways in which we are focusing strengthening, and accelerating pepfar's efforts and partnerships will hasten our arrival. thank you again for the opportunity to be here before you today. i am profoundly grateful for your ongoing and continuous unwaving support of this subcommittee more pepfar. i look forward to your questions pchlgt . >> thank you very much. i'd like to mention bono could not be here today. he wanted to be. he's had a very difficult accident. he's doing better, but just want to recognize his contribution to this cause. he's communicated with me several times, regretting not being able to be here. but the one foundation is sort of one

of the anchor tenants of this whole effort worldwide. so i just want to recognize the fact that he is with us in spirit. >> could i just interject there? he's also kept his good sense of humor. when i called him to -- after his accident back in dublin, he said, well, the fellow members of the band said it's a good thing he was wearing his helmet so he didn't damage the sidewalks of new york. >> friends like that. mark? >> thank you very much, mr. chairman. thank you for your leadership. this committee this chamber, this congress and two administrations have reached across party lines to reach those in need. your compassion and insight reflect the best of the american people. you've changed the landscape from working -- to being on brink of ending three plagues, two that have been around since recorded medical history and the modern black death, on the path to

extinction. while building resilient health systems resilient societies and resilient economies. thanks also for include megain this panel. it's a little humbling to be here with a world-famous preacher, a world-famous performer, and an expert scientist. i'll try to do my best to make three points. with your leadership, continued leadership, we can make history, strengthen partnership through shared responsibility, and drive innovation. advances in science, which i know you've heard about before, and also the experience of the investment you have made over the last 15 years have put us on the brink of ending malaria and tuberculosis, that have been around since recorded medical history, and hiv/a.i.d.s., in the path to not be epidemics anymore, to end them as public health threats. with your leadership, these infections have dropped dramatically. for example, 55 countries are on the path by the end of next year to reduce

malaria by 75% and 26 of them are on the path to elimination. there's been remarkable progress in reducing deaths, but we now have a clear choice as ambassador pointed out. the global funds contributed to this progress, we've raised about $4 billion a year, in part through your generosity n large part through your generosity, and have contributed to putting 7.3 million people on anti-viral treatment. 12 million have been tested and effectively treated for tuberculosis. global fund is the largest funder of tb and malaria external financing. these efforts are incredibly important. but as chairman

graham pointed out, beyond the health of individuals, these diseases have enormous impact on economic loss in the developing world. for example, it's estimated that nigeria alone loses $3.5 billion per year in its gdp because of malaria. the reality is healthy, productive people make healthy, productive nations and good trading partners. it's therefore not just an issue of public health but also economic interest to accelerate our progress towards ending these diseases. but as we pointed out, you've all pointed out by working together we can also brenging out the best in humanity. ambassador mentioned young women. young women are often five to ten times more likely to be infected than young boys. five to ten times more likely. they are driving the epidemic. with the youth bulge, the increase in young

people, there's the risk of an explosion undermining the progress that's been made. but new data suggests if we can work just to support and keep girls in school, hiv rates can drop by 60%. if those girls stay in school, they also don't get married early, don't get pregnant early, have economic opportunity, and they'll reinvest in health, education, nutrition, and bringing the opportunity to their children. we're working closely with the dreams initiative, pepfar, the gates foundation, and others to in intervene here. investments in hiv, tb, and malaria are bringing a broad pods positive effect on overall health systems in general. women were trained to go door to door to fight ebola. how do we achieve the lofty goals of ending epidemics and building resilient health systems and societies? we do it through

partnership. the global fund is probably the world's largest public-private partnership. we're actually the public-private partnership arm of the u.s. government's response to these diseases. we work so closely with ambassador burkes initiative and others. for every dollar the u.s. contributes to the global fund we leverage $22 from over 25 countries, the european commission, private foundations, and the faith community. as part of the fund's new approach to financing, we're requiring countries to match what we invest in, what you invest in to unlock the resources. so far, we have leveraged $3.9 billion in the past two years in order to increase countries' own contribution to fighting their epidemics. as we know, based on u.n. aid's reports, countries are now investing more on hiv than the external financing, which is pretty remarkable. it's been happening since 2012. they've long provided 80% of the financing for tuberculosis and more for malaria. so this increase in

country contribution is critical. but the private sector is as well. the global fund has had $1.7 billion contributed to it from the private sector while bill and melinda gates have been the largest contributors, bono through product red, something he created, and its corporate partners have contributed over $300 million. we're also accessing high net worth individuals from countries like india, indonesia, south africa vietnam. we have commitments of over $100 million from these individuals, and we are working to get more. the faith community has done a remarkable job, both as implementers, where we fund 73% of them, but also as funders. bishop bickerton of the united method dis church handed over a church for $9 million last week up on the hill. rick warren and his group have done a remarkable job advancing the fight against the disease. and people like elton john get deep into the community to ensure that those

left behind, those people in the community are not left behind. the private sector not only gives money, they also partner with us to do things. coca-cola is working with us to ensure distribution. who better to work with on distribution of drugs and commodities get to people. we are reducing the price of commodities. in two years through an initiative called -- an initiative we've launched, we saved $500 million by better negotiations. now that's value for money. mr. chairman, ranking member leahy, and distinguishing members, you are the leaders that will make this happen. thank you for your support, and we look forward to continuing to working with you and serving you as your public-private partnership arm to fight these diseases. >> dr. warren. >> chairman graham and ranking member leahy and members of the subcommittee, thank you for inviting me to testify here today. i have so much respect and

admiration for all of you. i agree that the 150 account is probably the most effective account in the united states budget. what you're doing matters to our nation. it matters to the world. and it actually is a matter of life and death to millions of people around the world. i'm not just pastor of saddleback church, i'm the founder of the global peace plan, which has sent teams to 197 countries. i've sent in my own church 24,869 of my members have served in 197 countries, which is 57 more countries than the peace corps has served. by the way, before i address the matter of dploebl health, i just want to say thank you for your previous hearing on protecting religious liberty abroad. it's a big issue, and i've spoken to that in my printed remarks. as you know from your hearings previously, we're making a lot of progress on the pandemics

like hiv, malaria, and tb. while the momentum is headed in the right direction, now is the time to move for eradication. a lot of times in the third quarter of a game, people say, we know how the outcome is going to happen so let's just let off the pedal. they'll leave the game. we can't do that now. the super bowl is a good example of what happens in the last second of a game. and i believe that it will take three catalytic factors in order to eradicate hiv malaria, and tb. first we must form a new perspective on foreign assistance. second, we must forge a new perspective, a new partnership in distribution. and third, we must fund a new priority in the budget, which would include ending sequestration. i've covered this in detail in my written testimony. i want to spend most of the time on partnerships and new

distribution, but let me make a comment on forming a new perspective on assistance. there are voices today who sincerely believe that we should either cut back or eliminate all foreign assistance. this idea resonates with a lot of voters for a couple reasons. first, they have no idea that this amount is actually less than 1% of the budget. they think it's a big amount. it's not. and second they don't realize the strategic value of foreign assistance. they've never considered that the right kind of foreign assistance, especially for health, education, and development, may be our most effective and cost-efficient strategy for security against the next generation of terrorism. this is what i mean by new perspective. now, proverbs 3:27 in the bible tells us it's morally wrong to withhold assistance for those who need it. but there are also strategic reasons why it would be shortsighted and unwise to cut back our assistance in global health. first, when america saves the lives of dying people from preventible

diseases, we make friends. that's obvious. and around the world, i've often been told, please thank americans for pepfar. it saved my husband's life, saved my wife's life, my childrens' lives, kept my family from economic disaster, and we'll always be grateful to america and we pray for you. now, when we make friends like that by saving lives, potential enemies are turned into grateful allies. if somebody saves your life, you have zero desire to terrorize them. in my travels, i've observed when poor countries are overwhelmed by these pandemics and they're stuck in poverty and have no capital to create opportunities, they get resentful of nations that ignore their plight. that resentment makes them ripe for angry ideologies. so it's far more effective, far more cost effective, far cheaper for americans to send medicine and make friends now than to send troops to fight enemies later. medicines cost less than tanks.

the resources we budget for humanitarian relief help programs, economic development education, training, can really save us from spending far, far more when resentment boils over. that's the new perspective i'm talking about. we need to frame this not as just it's some charity we do. it's strategically smart for america's security and safety to help people who are in pain. now, the second catalyst in eradicating preventable diseases is we have to forge new partnerships in distribution. sometimes you have to team tackle a player on a football field. he's so big, one person can't take him down. and this is where i call into reference what i call the three legs of the stool. a one-legged stool will fall over, and a two-legged stool will fall over, but a three-legged stool stands. i've been invited to speak at davos world economic forum multiple times. every time i hear people saying we need public and private partnerships. whenever i hear that i, i said, you're right,

but you're only two-thirds of the way. you're leaving out the biggest sector. that's the faith sector. let me put this in per spect i have. there are 600 million buddhists in the world. there are 800 million hindus in the world. there are 1.5 billion muslims in the world and 2.3 billion christians in the world. the actual number of people without faith is quite small outside of manhattan and parts of europe. most people have a faith. and if you want to talk about distribution, you have to use faith communities. i could take you to 10 million villages around the world. the only thing in it's a church. in much of the world, the church is the only social sector outside of the capital. and even if we have all the meds for tb a.i.d.s., hiv, malaria, and all the other diseases, the issue of distribution will not be solved unless we mobilize local

churches. let me just give you one illustration. at the end of president bush's term of office, he invited me to be the closing speaker at the global summit on malaria. i said, i'll come if i can bring some pastors from africa. so i did. and at the end of the talk, i stood up and said, i'm going to show you three slides that show you why you can't solve any global problem without the faith community. so i put up -- i said, let me just show you one example. i've been in 164 countries, but this is just one. rwanda. i said, we went there and we said, what would you like? they said the western province of rwanda needs health care. i put up a sign, a map of western rwanda. i said, here are the three hospitals for about a million people. it's a two day's walk to any of these hospitals. that's not good enough health care, to have to walk two days to get your

health care. now, by way, two of these three hospitals, they're faith based. so you wouldn't even have them if it weren't for the church. i put up the next slide. here are 18 clinics. these 18 clinics, now it's only a day's walk. if you've been to developing countries, a clinic is often a bottle of aspirin on the shelf or less than that. i said, that's better than three hospitals, but by the way, only 16 of those are faith based, and you wouldn't have those without the church. now i said, watch this. i put up the third map. it was covered with dots. i said here are the over 600 churches in this division. where would you like to get your health care? two day's walk, one day's walk, or five minutes away? melinda gates was sitting in the front row. she said, i get it, rick. the church could be the distribution center for health care. i said, melinda, it has been for 2,000 years. let's put this in perspective. the church invented the hospital. and if we're going to absolutely eradicate these diseases, we've got to do a combination of the

public sector, the private sector, and the faith sector the three legs of the stool. again, i would encourage, if there's any way we could end sequestration, i'm in favor of that. there are a lot of areas i think we could cut the budget. this is one area of the budget that should be increased for strategic reasonings. thank you. >> thank you very much, rick. sir elton john. >> thank you very much. mr. chairman, senator leahy, and members of the subcommittee, thank you for the opportunity to let me testify this morning. it's a very daunting task sitting at a table with three amazing people who are in the trenches every day, fighting this disease who do incredible work. i'm very humbled by being here and humbled amongst the company i'm keeping. in 2003 at the invitation of senator

ted kennedy, i had the honor of speaking before the senate health committee in my capacity as the founder of the elton john a.i.d.s. foundation. i created the foundation in 1992 to address the dire need to provide basic services and support to those dying from a.i.d.s. over the past 23 years, we have raised over $321 million to fund organizations that provide direct treatment and prevention efforts in dozens of countries around the globe. the first time i testified before congress 12 years ago, almost no one had access to antiretro viral medicine in subsaharan africa where the epidemic was most acute. people were being infected and dying by the millions, even though we very literally had the drugs that could save their lives in our hands. at that point, 12 million children in subsaharan africa had been orphaned by a.i.d.s. they declared a.i.d.s. to be a state of emergency

worldwide, more than 30 million people were hiv positive. the disease left nothing but despair, ruin, and fear in its wake. i saw it with my own eyes as i traveled to the hardest hit regions on behalf of my foundation. without the funds needed to make life-saving drugs available in africa, my foundation invested in dramatically expanding palliative care and a hospice network. across south africa uganda, and kenya, we helped give a dignified death to more than 800,000 men, women, and children. then we provided food, shelter, and basic education to over 3 million orphans left in their wake. it was a compassionate response but it didn't solve the problem. in those years, the epidemic was only escalating until in a time of great need and urgency, a republican president and a bipartisan majority in the united states

congress created pepfar. the president's emergency plan for a.i.d.s. relief. compassionate leaders from both sides of the aisle said to the international community, america can and america will lead the world in the global fight against a.i.d.s. today, thanks to the unprecedented actions of congress, an hiv positive mother in south africa can give birth to a healthy hiv-free baby who she can live to raise. today, thanks to the generosity of the american people, 9.4 million men, women, and children have access to life-saving antiretro viral treatments. where there was once despair, ruin, and fear there is now hope, life, laughter, and love. pepfar has done more than just save lives.

it has provided basic infrastructure and trained more than 100,000 health care workers to prevent future outbreaks in countries like botswana, tanzania, kenya, and uganda. congress' strong support for the global fund for a.i.d.s., tb, and malaria has enabled it to generate investments from governments and corporations worldwide and leverage $2 for every $1 invested by the united states, therefore expanding its reach and impact. i'm grateful this has included up to 1 billion pounds from the united kingdom over the past three years. congress' leadership has been transformational. what we once invested in hospice to care for the dying has been repurposed to treat the living. my foundation has tested over 3 million people for hiv in africa and linked more than 400,000 patients to life-saving treatment on the continent since 2012. combined with

efforts funded by the united states, we've contributed to the 48% global reduction in mother-to-child transmission of hiv. in short, we're no longer bailing out a sinking ship, we are helping steer it into a safe harbor. mr. chairman, because of the actions of this congress, the course of the a.i.d.s. epidemic was altered for all of huemanityhumanity. because of the american people had the optimism, the ingenuity, and the will to make a difference the lives of millions of people half way around the world have been saved. but i'm here today with a simple message. the a.i.d.s. epidemic is not over, and america's continued leadership is critical. there united states a window of opportunity before us, a window through which we can clearly see the end of aids within my lifetime. we cannot afford to let the window close. if our efforts

flag, drug resistance will surface, transmission rates rise and this disease will once again become a ruthless pandemic with disastrous and far-reaching consequences. i have stood in too many -- at too many bedsides in america england, across africa helplessly watching people die in pain. to bear the thought that we might go back to those dark days is unthinkable. on the other hand, if we continue to the historic work of pepfar and the global fund, if we honor the 40 million lives lost over the past three decades we can and will see the day when aids is no longer a horrifying global killer but a contained and controlled chronic illness. mr. chairman, this is most powerful legislative body in the world and this congress, indeed, has the power to end

aids. you have the power to maintain america's historic commitment to leading the global campaign against this disease. i'm here today to ask you to use that power to seize this window of opportunity to change the course of history. and one day soon i hope to extend my thanks to you to this congress, to the united states of america, not only for fighting this disease, but for ending it once and for all. thank you. >> end it right on time, it's amazing. after this, how would you like to vote against this account? what would you say? the terrorists want you to vote no i guess that's the only thing i can think about. so anyway mark, name countries that could do more that are not. >> thank you, mr. chairman. it's a long list, i just came

from one, china, actually, arriving last night. they once received resources from the global fund but now are giving. they've transited out. >> could they do more? there they can, and we are working to invest with them more. >> what about the gulf countries. >> the gulf countries could definitely do considerably more in the fight against the three diseases. parts of southeast asia, thailand transitioning from a support from a recipient of the global fund â >> we're not asking people to give who've got their own problems. talking about people who have some economic ability to give that are not. >> these countries do have considerable economic ability and they are stepping up. >> what about europe? how would you rate europe's response? >> europe is doing quite well in a number of places. the uk, sir elton john mentioned, frabs thence the second largest contributor. >> germany. >> currently number five -- six. japan number five. >> in terms of economic power in europe, how does germany

rank? >> certainly number one. >> so they're number five on giving, number one in economic? >> through the global fund they've increased it commentment to us and to do even more. >> thank you very much. rick these churches that are new distribution network, will you take anybody that comes? >> absolutely. in fact -- absolutely. in fact after i made that presentation at president bush's malaria conference i said i'm going to prove that i can do it faster than any ngo or government. i went to that area of rwanda and i asked pastors, i said, would you be interested in us training in your people in basic health care? there will never be enough doctors in the world. 18 pastors said yes. i said grab two people from your congregation, we'll start training them in basic health karp care. the muslims said,

will you train us? we said sure. you pick two out of your movings. there were two mosques that show people to be trained. that group grew to 60. we trained them to 120 and then we 340 and on and on, we kept multiplying. this last august i went to that area of rwanda and did a rally for over 3,000 trained health care workers who each visit seven families a week. they make hospital calls house visits, and we did it with little, very little money. these people are saying, we started off with simple stuff, like wash your hands, hang up the sheets to dry, how to do sanitation, dressing wounds, stitching a wound. they can learn things like how to administer arvs and how to do peer -- what's the word i want? peer coaching to make sure that

they do their compliant with the drugs. it it can be done. and now we have many other countries asking for the same model. >> madam ambassador, what will sequestration do to our ability to get this thing put away in terms of aids and how would it affect the pepfar program if we fully implement sequestration? >> i think you heard from my testimony that we're doing everything that we can to focus every dollar we have because there's always more need than there are dollars. so we talk a very strong responsibility in ensuring that we focus dollars we have optimally. any cut in those dollars â >> you know how much the program would be cut by 2021? >> you have mentioned it would be quite extraordinary there you have to find a number. i want you to go find a number and tell me. if you don't know that number you need to know it. >> we will find that and get if for you.

>> i want everybody, the global fund, i want the number. you have x dollars today, you're going to have y dollars tomorrow, this is what it it means. you should know these numbers because they're dramatic. sir elton john, you've been following this battle for a long time, you say we're close. what's the biggest -- what's your worst fear? >> worst fear is stigma to be honest with you. we are seeing especially in african countries lgbt community suffering under draconian laws. when people like that who are suffering from hiv are penalized, they go underground and the disease is spread further. stigmatizing people because they have hiv is the worst thing one can do. that's for me the biggest

problem that we face. once we get people on drug, it's fantastic. but getting people to feel unashamed, to feel they're okay with the virus, not to feel as if they're being threatened by their own government because they may have a sexual orientation the leader of the government doesn't approve of is incredibly important. not only a humane crime, it is a medical crime as well. there's two sides to that coin. one, you're telling people that they're worthless and, two, people that are worthless that are sick, telling them they're not treatable. you're driving them underground. you're making them feel worthless. my whole thing with my organization, my foundation, nobody should be left behind. we live in a world so narcissistic, the world needs compassion. the world needs leaders to show compassion. the current pope is someone who i revere very much because he's showing more compassion in the humane way

than two predesesers did. this is vital to the recovery of self-belief, self-worth in this world. people are told they're worthless and unloved, where are we as human beings? if christ was alive today -- and i believe in christ -- he would be appalled at the way people are being stigmatized. we need people to be included to feel love and compassion. without that ingredient in this mixture of med isn't and everything else we face an ongoing battle. i encourage governments throughout the world who are you know, saying homosexuality is a sin and everything like that, they are making their disease worse and the long consequences for that for that country, their xheer's goeconomy's going to suffer. it's inhumane and inhumane to people suffering from the disease. >> from a piftrivate sector, have you been able to raise

adequate amount of funds though the economy's crippled throughout the world or are people still giving? >> they are. we have many other rivals and very -- there's a lot of people suffering from many diseases. but as pepfar's done, it's treated malaria, t.b., and the more you teach people -- as rick was saying to train people, train in countries where they haven't got enough medical staff, if you train people to look at people, in africa, for example, when we started people aren't used to taking a pill, they're not used to that. >> right. >> they're used to having the local traditional healer give them something. it's a mat or of education. and i think once you tell people, if i have an event, we'll build somewhere to educate people or mothers-to-mothers tranmission and you can see this is improving knowledge of the disease and the treatment that you're going to give people, people will dip into their pockets. and i think, when we started it off with this disease, there were so many

different foundations. there's not many standing but we work together. i think we're a very strong force. and i think we're a force for good and i think we're very -- we had a meeting last night, the camaraderie and the feeling i get from the american people is so touching you have to remember, i'm british, i've come over here in 1970 and the country gave everything to me as a professional musician and as a human beingen the strength and the willingness to help people in the rest of the world has touched me so much. it was ryan white who pointed it out to me that my life was completely disorder. i was a drug addict, i was a self-obsess ed self-obsessed asshole, excuse me, ryan white and his family turned my life around because he was a young boy who had aids, a hemophiliac, treated badly by people ignorant and

new better, and he never got angry and forgave forgave. we have to have compassion, forgiveness, inclusion of everybody whether intravenous drug users, whether it's prisoners, whether it's people who are gay, whether it's transgender people, we are all human beings. we're all children of god. and if we throw that away, then we're throwing everything down the drain. so, when i explain this to people, and people are good people -- i believe in the goodness of the human spirit. look at this room here, for example. we don't have any problems raising money. the a long-winded answer to your question. but no, people are generous. you explain to them where their money's going and show them what it's doing, they will dip into their pockets. >> thank you, senator leahy? >> thank you, mr. chairman. i didn't think it was long-winded at all, it's a subject that should be heard over and over and over again. one thing, ambassador birx, dr.

dybul, the question asked on dollars, please give us -- be very honest and very direct in what some of the sequestration things would count. tim in my office who worked on this, janis, alex, far more knowledgeable in the nitty-gritty than i am. the numbers i'm seeing are devastating, devastating. and they're not anywhere near the numbers that senator graham and i and the bipartisan way have supported in the past. don't sugarcoat it. make it very clear. and sir el tonight you talked about how much less expensive it is for prevention than care after the fact. i'm

aware of that. i know pastor warren and i have talked about this before. you were mentioning quilt, when you were speaking last night. i think my dear friend i grew up with from vermont, when he was diagnosed and he was a public figure in vermont, rest his soul, he -- when he was first diagnosed, i remember being ostracized, my wife and i came to a large gathering and people were trying to avoid him. this is some years back. my wife is a registered nurse, she walked up and gave him a great big hug and a kiss and he said right to the time he died, that changed his life because after that, people that avoided him because they knew my wife. she's actually more -- more popular

in vermont than i am. they saw marcel do that and they went up. so keep on pointing that out. it's not long-winded. it's important. even today people need to hear that. we have known about hiv and aids for more than 30 years. but it's still a huge health -- even here in united states, we have pockets in the united states for instance, where it's growing. you would think that with all of the education, it it would be cutting back. what -- things we should be doing differently in combatting this? are we focusing on the right countries? we know we're going to have a finite amount of money. how do we spend it best?

>> me? >> yeah. sorry to put you on the spot. but we're struggling for that here. how do you spend it best? well, you -- you still continue what you're doing. pepfar is doing, giving anti-retro viral drugs to people that can't have access to them. getting the infrastructure in countries where there is no infrastructure so that people can receive drugs and get them on a daily basis, because a lot of the people live in rural areas and don't know how to do it. and you have to educate. you have to educate people. education is very important. prevention is very important. and you heard earlier that young juvenile women in africa are accounting for, you know juvenile women now, it the second cause of death, largest cause of the death in the world is young juvenile women through aids. this is catastrophic. you have to educate them. you have to spend the money very, very wisely. that's all i can say.

mark, anything to add on that or not? >> after the senate. >> we all talk about the thing that's -- dr. dybul, we're seeing increases in parts of this country. i mean, you would think that it would be decreasing everywhere in the world once sir elton talked about with young ghim africa. we're seeing it, men and women in this country. what's -- whereby are we missing the point? >> i don't know in rural south it's a very big problem. among young, gay men, having sex with men, it's a big problem. i think maybe because they feel that they are not going to die that this disease has -- you know we mentioned it, someone mentioned it, you know, this

disease can be a manageable disease, you can live with this disease. and i think, in this country, which has all of the sophisticated medicine available, that people are having unsafe sex, thinking if i have unsafe sex, i'm going to be okay because there's a pill i can take. not really knowing or understanding consequences of what that pill might do to that their body in the long run. but in africa they don't have that option. they just want to live. over here, they're able to live because they have med isn't available. and africa and asia, they don't have that option some of the people because they don't have the medicine. and i think you have seen a rise, a -- it's cyclical, seems to happen every ten years, that this disease starts to rise again amongst the young. and i'm at a loss to explain it because, you know, everyone knows consequences of being hiv positive. as i say you can live

a safe and healthy life like a diabetic. easier to treat someone with hiv than a diabetic than would be my explanation, why you're seeing a rise. in the rural south it's -- it is also a huge problem as well. and i think, again, a lot of it is stigma. a lot of people not wanting to admit they have the disease. not a lot of people are being tested. not a lot of people being tested. a lot of people are walking around not knowing they have the disease. there's still a lot of fear. even in the countries so sophisticated as america and in my country, great britain, the 15 same thing is occurring. >> doctor, my last question, and i have to ask questions all day long, but i -- the president's fiscal year 2016 request for pep for, this is $300 million impact fund, this award governments ta take steps

to, as i understand, realign the national programs to combat hiv-aids in the most areas most severely affected. i understand you're implementing a similar realignment of pepfar funds. now some who challenge that say there are areas that are going to receive less funding and that's going to be severe impact on them. would you like to explain what's happening? >> thank you, senator. so there's two things that we're doing. we are fortunate because of the way congress set up pepfar that we have very granular data down to the site level. we know precisely where there's hiv and where there isn't hiv. and what we have found over the last ten years is a real evolution that in areas where there's very little hiv we have excellent coverage of all

services sometimes over 100% because people have come over to the border to access services. and in areas where hiv is the most prevalent, where the incident is the highest, say kenya, our service delivery is at a 30% to 45%. we've created an inequity between areas where we've been overserving and areas where we've been substantially underserving the population. and working with governments to go through that information in a careful way so that what you just described at the end of the question doesn't happen. we are committed, obviously, to maintaining all of the services in the areas that are very low burden and are working with governments and global fund to ensure that there's a safety net. we're also working geographically mapping the sites down to the absolute precise gps coordinates so we can tell you that there's ten sites here all within a half a

kilometer and we only need two. it would be much more effect touv have two site there's, all within walking distance, all within less than a half hour walking distance, and increase the number of sites in the very high burden areas. because what is happening, if you're a pregnant woman, you have a much lower chance of being diagnosed and linked to services than if you're a pregnant woman in kenya and it's only 50 kilometers away. this is the type of work we've been doing. >> thank you. senator? >> thank you, chairman graham. i want to thank the passion and compassion of the panel today. greatly appreciated, in a city not characterized by compassion, you bring that here today and we thank you for that. i was struck, sir elton john by a statement you made in your testimony, there's a window of opportunity before us, a window through which we can clear willy see the end of aids within my lifetime. what is the greatest barrier that you see

to accomplishing that goal? >> well, reduction in funs of pepfar funds of peplar. the world has to step up and and keep the funding going. the more funds we get, the more we can educate them. let me put this bluntly. we've talked eded subsaharan africa. i have a suspicion that it's not great. but they don't talk about it because it's, you know, not part of their think to admit that they have a huge problem. so the more money that's given the more we can -- once those figures are released -- and we don't know anything about china either -- we have to maintain the funding. that is the biggest, biggest thing that we

have to do. and we have to educate people. and we have the stigma, again, we have to make people feel that they're loved and not shamed. that's a big issue. u think rick would agree. >> absolutely. >> what he does with the chushg the church preaches love. that's what we must also do. preaches love. that's what we must also do. but along with the funding which is so essential, that's why i'm here today, we're all here today, saying we hope that the united states government and congress and the senate will not cut the funding of pepfar because if they do it's going to be a complete disaster again. we're going to go back to square one, it's only going to get worse. so it's a mixture of coming together, everybody, everybody some other countries have to step up to the plate here. america can't do this all on its own. i don't think eu is doing enough. obviously china's not doing enough. japan's not doing enough. these are countries that can afford to do it. as a panel of people we have to say, what can we do here to make those people step up to the plate and make sure america is not the only country in the world that's doing this.

it can't. it can only provide 33% of the global fund. so as a panel here, we have to go away and say, listen other countries need to step up to the plate. the funding is so important. the more money, the more we can stabilize the world and more compassion we can show to people with aids, that's the way to go. it's a mixture of both. i wouldn't say it's an easy solution. sen. daines: thank you for that thoughtful response on it. i want to pivot over here for a moment and ask dr. warren a question. in your testimony you call religious liberty america's first freedom. i think you made opening remarks thanking the panel for those

protects, fighting for that. it's the first phrase of the first sentence in the first amendment of the bill of rights. our founding fathers obviously cared a great deal about the issue -- as i though you do as well -- and the fight for religious freedom was fundamental in the country's fight for independence. your view, what is state of religious liberty in the country today? are we doing enough to protect? dr. warren: as i pointed out in my written testimony, religious liberty is what america was founded on. it's the first freedom. that's not by accident. we call it the first freedom. the first phrase of the first sentence of the first paragraph of the first amendment. it comes before freedom of speech, before freedom of the press, before freedom to assemble, before every other freedom if i do not have the freedom of conscience to believe what i want to believe, i don't need free democrat of speech. i don't have the freedom to believe what i want to believe, i don't have the freedom to assemble. so, that's very extremely important.

it's all part of what i call holistic assistance, that the kind of assistance that is needed around the world is it's not just meds aren't enough. we have to do all -- the whole reason we started the peace plan when we started dealing with people who aids, we realized oh, they need education oh, they need job training. oh, there's poverty issues here. and all of these things are holistic holistic. as a church, all of the things that elton was talking about, we have a little -- we say there's six things the church can do. we care for and support the sick, that's the c. handle testing and counseling. we, u, unleash arm over volunteers. r, remove the stigma. the c, we champion healthy behavior. and we, h, help with nutrition and medicine. it's a holistic approach. you can't do one thing. relewous liberty falls into that.

i think it's just one of the other factors. i've actually had debates on this in china with the chinese. dr. warren: back to a comment that elton john made about the need for funding, you mentioned in your testimony that tax code ensenty advise generosity. sen. daines: --sen. daines: back to a comment that elton john made about the need for funding, you mentioned in your testimony that tax code ensenty advise generosity. dr. warren: i believe that. sen. daines: what do you view of the importance of charitable donations to efforts to fight poverty, to fight aids and global health issues in the u.s. and overseas?

dr. warren: well, as a pastor of course i'm interested in people's personal growth and growth in character. if you tax me and then use that money to help the poor, i don't get any credit for it. if you incentivize my generosity and then i am generous, i actually grow in character by being generous. i'm obviously in favor of the government funding and increasing funding for these kind of things. i think there are a lot of things we could cut and this should be expanded. i believe 150 line item really does need to be expanded. it's so miniscule, we get more bang for the buck. but i believe at the same time -- this is probably not the committee for it -- we ought to incentivize generosity. the tax code should reward generosity rather than cap. of course americans are the most generous nations there is weep could be even more generous if we create a system that encourages it. people, whatever is rewarded is repeated. sen. daines: thank you. >> thanks, mr. chairman. >> thank you, chairman graham. i between start by thanking you, ranking member leahy for your bipartisan, commitment, we have hearings that we look hard at human sufficient, and

-- human suffering and opportunities we have to do good in the world but to do good well and do in a way that is sustainable and bipartisan and effective. i appreciate your leadership on these important and valuable issues. i want to thank the panel today for reminding us of what it means to be american and what we can do when we do the best in our national spirit and we bring our best capabilities to the fore. reverend warren, i appreciate your reminding us we have a scriptural injunction. sir elton john, i appreciated your compelling and personal testimony about how a change in your own life was brought forward by ryan white and the dramatic impact that you've made across the world and how the two of you in partnership are helping demonstrate what it means to accept, to welcome, to love and celebrate wide range of people who are otherwise suffering. i agree with you that fighting stigma against lgbt community africa is one of the most important things we can do to avoid marginalization, to avoid the spread of the disease and

show our humanity. in my limited opportunities, as the africa subcommittee chair the last fouriers, visiting 15 one countries i've tried to press that point because the human consequence of ongoing oppression based on orientation are very real. this is a very real threat across the world. mr. dybul, thank you so much for your leadership of the global fun. i introduced a maternal and child health bill which i'm hoping we renew in this congress that would give access to innovative financing techniques to strengthen the amount of resources available for maternal and child health. that's the core issue we're talking about here today, how to sus stan a difficult budget vital investments. what are the opportunities here for innovateive financing?

what, if anything, do we need to be doing legislatively to help facilitate that? dr. dybul: thank you, senator. innovative finance is a big field. one of the most important things to do is get other countries to contribute, as the chairman was mentioning and we are actively pushing on that all around the world, not just from traditional donors but others. i would amend, germany's number four, i got that wrong. but the innovative finance field -- i can give you examples -- is extraordinary opportunity. so social impact moms, nigeria they have a $400 million gap to meet their ned. we say we'll give you 50 if you cover the other 50. they're going to float a bond float a bond in order to cover the $50 million. that's one opportunity. another high net worth individuals. we are actively pursuing high net worth individuals. we understand all accounts are constrained all over the world.

we need the private sector to be doing more. high net worth individuals have enormous wealth. we've raised $100 million working with bill gates and others. but we see huge opportunity. it not just money, it's hour we're going to use. we're trying to build trust funds, public sector, private sector trust funds that match the public sector investments. these does these things, one puts more money in. often high net worth individuals in korea, china, vietnam are among the most influential people in the countries and worth billions of dollars. they are putting pressure on the government to increase their contribution because they're putting in money, too. the third around innovative implementation, they're saying if i put money in, i want an efficient system. let's work together on supply chain, procurement systems, work together to bring private sector practices. those innovative trust funds are huge opportunities for us as we

are moving so countries are funding more and more of their own programs. there are many other opportunities around innovative finance that we're exploring. countries are doing extraordinary things. senegal and kenya and tanzania have some of the mosten know -- most innovative programs doing special tax schemes, special bonds and funds internally to raise money within their own country. a huge opportunity. thank you for raising it. sen. coons: i just visit senegal and kenya last month. as both sir elton john and reverend warren have shown the capacity of the private sector and charitable individuals to make a significant impact is impressive and need to deploy further. dr. burks -- birx, as we saw in the response to ebola, there were americans and folks around the world who stepped forward and made individual contributions in the hundreds of millions of dollars that helped

accelerate eu engagement multilateral engagement. one of either lesson of the ebola experience, pepfar training with nigeria to rapidly identify and contain one outbreak of ebola. what are you doing -- what is the path forward for integrating pepfar systems to prepare for the next pandemic, tell us just more, if you would, about two programs, the act program, accelerating children's hiv-aids treatment and the dreams initiative which you mentioned in passing but i'd love to hear more about in the minute and a half we've got. dr birx: great. thank you. so we have intentionally strengthened health systems because without health system that can provide commodities without a health system that can diagnose disease at the laboratory level, without a health system that has health provider as the health center, it wasn't going to be a functional system. it's been very deliberative and very much matched the services we're providing.

a nurse at a health center though providing hiv tests and referring patients and often treating patients, she's treating all patients in the community. so although they may be trained and provided by pepfar, they're there for the community. and i think we've seen in every other ebola outbreak that has occurred in the democraticrc uganda, a rapid community response and rapid medical and scientific response because of the infrastructure that has been built in the pepfar countries. within nigeria, the felt program, field epidemiologic trained individuals there for polio, trained by pepfar but utilized in polio, became the core. but underneath all of that you have a global health core that's been funded and bill by pepfar around the world, thousands of individuals in countries who are part of the u.s. ambassador, who are also deployed to the countries and the immediate rapid responders. on the continent you have now

highly trained public health individuals, both host country nationals and direct hire staff. act and dreams are two exciting pieces. illustrates when you intentional intentionally seek private sector engagement around a core program that private sector will stand forward. so having the children's investment fund foundation come forward with $50 million made it it possible for actually to achieve the goal of doubling the number of children reached by pepfar. only 24% of the individuals children under 15 in need of treatment are receiving treatment. this was really a key initiative. the dreams initiative, mark and i are working closely on, to empower young women to remain hiv-free, statistics are overwhelming. 5%, 10%, 15%, 30% prevalence by 20 in areas of south africa. the same thing repeated over and over again. this is a program that i have to tell you, when i said that tis was high risk and entering into unknown territory, this is a program that we're relying on

completely different approach, ground up planning, bringing everything to the table from the social structure to the community structure to the family structure to the school structure to really figure out what the most disadvantaged young women need in order to remain hiv free. we have a lot of what we call monitoring evaluation around it so we can immediately tell what's working and transform it into the other country. thank you for those questions. sen. coons: thank you. i appreciate very hard work that you're doing with pepfar, you're doing with the global fund to make sure we have data, doing analysis, delivering services effectively as sir elton john's foundation has demonstrated, testing, better testing, bert integration at community level is vital. as reverend warren's community health training in rwanda and elsewhere demonstrated we can do this effectively but we have to do it in different ways, in a more sustainable way if the vision of the end of aids is to abbe be achieved.

thank you for your great work. sen. kirk: i prefer to call you colonel birx to make sure everybody knows about your service to the u.s. medical corps. when we first met, i told you the story -- i will tell other members of the subcommittee how we took the initiative in 1986 to start off the startings of this program. i will stay, senator leahy is not here, i think he was on a leadership in senate foreign ops. as a staffer i went to congressman bob mirazic of new york and started $25 million earmark to start the global program in aids as it was called. the reason why we were leading to do that is the first diagnostic kit produced by abbott labor tos which is from illinois. and we got the results from abbott that they had, they said, they had a rate that was very high according to models.

the epidemic going on for 50 years. we got very brave bob to see dave obie and he said something, as though who worked with dave i'll be god damned if estart a disease account with an earmark. luckily, dave changed his mind to his eternal credit. for dr. dybul, i see you as the successor to my great partner in the work, dr. jonathan mann when we lost in the swiss aircraft with his wife. he told us the need to have a multilateral and bilateral program. i between just put before you guys pepfar started with bilateral routes and because of the old bilateral roots it doesn't really work massively enough in mexico.

a country we should be concerned about. with the disease state, i think that shows the advantage of the global fund to make sure they're working. all countries of great concern. we say -- i went to school in mexico. remember, so far from the god and so near to the united states. we have a long time historic problem of mexico taking direct foreign aid and i would say for mark, it's very important we have the flexibility. the thing that dr. mann said, he said, you've got to start a bilateral program. don't work with w.h.o. africa because the team is too corrupt.

i would say that deborah, you represent the u.s. government, accountable to congress and to gao effective delivery. i would say to this committee you never know what you're working on. this thing started as $25 million earmark, now it's $4 billion. i saw from the chairman's notes we spent $57 billion on pepfar. i sit back after this work 30 year as ago thinking you are talking about how we got to remind the public that the aids epidemic is still very much with us. that just warms my heart to think of all of the positive work never in the history of mankind has one country given such an investment to health care internationally. >> mr. chairman.

sen. graham: thank you. wonderful question. that was great. to the stenographer, you're going to have your work cut out for you. earthy committee we have here. well done, mark, thanks of your years of ininvolvement. senator shaheen. sen. shaheen: thank you for being here this morning and for the wonderful work that you're doing around the world. ambassador birx and and dr. dybul, i want to start with you all. i find the statistic that over 80% of new hiv infections amongst adolescents in the hardest hit countries by aids is by young women. i wonder if you can talk to why that is and i think the dreams partnership is very exciting with nike and with the gates foundation. but can you speak to what the

solutions are as we think about how we prevent young women from being effective? infected, i guess i should say. ambassador birx? you want to go first? dr birx: thank you. i think this level of statistics, which nih has really helped with because it was clinical trials that pointed out the unrelenting incidents, the highest rate of new infects we have seen anywhere on the planet, 4% a year, 10% a year. i think al of us together started looking at this in a very detailed way. mark will also talk about how we've been work collectively because it will take a community and it will take a village. what puts young women at risk is a whole series of factors and one, if there is a silver bullet we would have already achieved it. there are probably 10, 15 things that have to be done together. what we're hoping is, a lot of studies have done one thing, either done education or cash transfer or they've done family strengthening. what we believe is if you put it together as a combination prevention activity, like we're doing for many other parts of the hiv program, that it will become synergistic so one plus one is now ten, because that's what we need with the number of young women. south africa alone, 3 million

young women in the vulnerable age group than the beginning of the epidemic. 3 million. sen. shaheen: what you're saying is that, like so many issues that affect women in developing countries, that the status of women in those societies is contributes to the tremendous effect from aids? dr birx: perfect way to put it. dr. dybul: that's exactly right, senator. i often get in trouble for insisting that young girls be considered what we call a key affect population because the discrimination stigma and inequality is really what's driving the issue. that's why it has to be broader than just saying we have services available because often they can't access those services, and girls outside school are disproportionally more at risk and transgenerational sex, lack of legal status, it's not being even registered when a girl is born.

it's a series of issues. as ambassador birx said there's no silver bullet just like there's no one explanation. you can go ten miles as part and see a completely different reason why a girl is vulner be. you'll see a 10-1 differential in the vulnerability. we have to be very sophisticated and go community by community. we have some indication of things that can be done like keeping girls in school that will have, as i mentioned, not only hiv impact we believe but then those ripple impacts on culture. so that the girl is expected to go to school, she's expected not to get married early or expected not to get pregnant early, these are things that would begin to change. perhaps getting people focused in -- focused on, if we don't know solutions what are solutions so we can come up with them? working on it collectively because it has to be collective effort. it is a group that has been left behind and that we have not

served properly. sen. shaheen: thank you. i'm working on girls count legislation to try to make sure we can get countries, as you know, to register when girls are born. reverend warren, i want to go to your comments about the importance. they were similar to the chairman's about the impact strategic impact that investing in these efforts make. they're not just important to the health and welfare of people in these countries but they help us in america. and i certainly agree with you about the influence of the faith sector sector. talk about how we can get the faith sector more involved and helping to educate and encourage americans to support foreign aid. you mentioned that many american people don't understand, they don't support foreign aid

because they think it's much greater in terms of the dollar amounts than it is how can we get the faith sector more involved? what do you see that's working? that way? dr. warren: well, i go back to this idea of assistance in aid being holistic. a lot of people don't really know what we do when we give money to other countries. they don't know what it's going for. in fact usually all we know what it's going for, we funded so many jets for a country or so many, you know, arms for a country. that's what's in the paper. you don't hear what america does for other countries outside of arming them. and that's a big issue there. one of the things that ambassador birx mentioned, and you mentioned, too, having the right information.

i have noticed that countries are hungry themselves for data collection. when i traveled to other countries, i would advise us fund data collection in other countries. that would be a wise use of american assistance dollars because without data collection you can't have a national plan for aids reduction, malaria reduction, t.b. reduction, things like that. i would say that what we need is smart aid and smart aid gives true accountability on both side that the donors are accountable to do what we say we're going to do and receivers are accountable on what they receive, and smart aid has an alignment with national plan. smart aid has a good accountability. smart aid has these data collection systems in place.

believe me, the poor countries aren't going to be able to afford data collection. sen. shaheen: i'm out of time. can i ask a follow-up? i think you're absolutely right about that, and i appreciate that. i guess can you talk more about how we can get the faith sector more involved in helping americans understand why these efforts are so important? dr. warren: you know, senator it's been my experience that the faith community has been more willing to partner than the government has been willing to partner back. the government is more afraid of the faith sector than the faith sector's afraid of government. i think if somebody raised up the flag and said, we are truly talking about partnerships, i've been on the hill now off and on for 20 years and heard so much about partnerships and nothing ever happens with it unless somebody on my side takes initiative. i think if others took initiative on the other two leg of the stool, and called some symposiums together, say, how do we do this?

we're good, the government is good at this, business and health care's good at this, what is the church good at it? it's good at distribution. it has -- in africa, they say the pastor sleeps in the same blankets as the community. you know, when -- i keep going back to rwanda, i've had 1,200 people in rewant dap when the genocide hit in 1994, every single ngo left the country. it was unsafe. who stayed? the church. because the church is the country. it is the country. and in most of the world you can't talk about community development without talking about the church. it's there. so i actually think they would step up to the plate instantly if there was a little love on this side. sen. shaheen: so, mr. chairman, i would suggest that we try to work with reverend warren as we're thinking about how we make sure we continue to fund the pepfar program.

sen. graham: absolutely. what you're trying to do is how do you brand this program in a positive way with the american taxpayers so they'll understand the return on investment. i've been thinking about that a lot and this panel helps. senator langford? sen. langford: thank all of you for being here and for the wores. pastor warren, let me finish up that conversation. have you seen effective outreach from government reaching out to the faith sector in any particular country that you've been around, that your church members worked and with that you've seen the connection with, with the united states government or other governments? dr. warren: i found it easy to work with other governments. they're not nearly as afraid of the church as the american government is. i mean, we work with governments literally all around the world and they're very, very friendly. because they realize we're not trying to do their work. everybody has a different role to play and the church's role is

not government. the government's role is not church. but on health issues, and on education issues and on development issues, you can team tackle. as i said, i found it easier to work with governments overseas. sen. langford: it is ironic we have distributed around the world concept of freedom of religion and disconnect of government and faith and say government doesn't oppose faith but someone that's afraid of faith and being able to partner, it's an obvious area of partnering when you talk about the number of hospitals and clings clinics versus churches and i hear experts on the medical side say one of the key thing to haves a distribution center in that location. how do we get that? i think we can't be afraid here of saying there's an obvious connection there. we're can connect, where we can find good distribution in relationships, let's do. it's one of our greatest challenges of getting to these areas with a relationship that is a trusted relationship to say this is a way to be able to deal with this disease or to be able to deal with this cultural issue

and let us engage with you in a relationship. so i appreciate all that you're doing on this. let me shift a little bit. i'm a little concerned, and this is one of the things that we deal with all of the time, dealing with funding side of what we're doing with this global fund receives $1.3 billion in fy-15. we have $4.3 billion for state departments hiv-aids program $330 million for usaid, hiv-aids programs, $128 million for hhs yeahs and hiv programs through the cdc, and $451 billion for nih global research. how are we doing on coordination? how is everyone doing talking to each other to make sure that everyone doesn't raise their hand and say there's a problem, and we all agree there's a massive problem, how's the coordination of the dollars going. does everyone have their

does everyone have their lane doing their job or do we see duplication? anyone who wants to jump into that, have at it. sen. shaheen: mark and i can answer that together. it's interesting how you put it dr birx: mark and i can answer that together. it's interesting how you put it together. thank you for framing it that way because you talked about our boss, because we both were in tony's lab at one time. and the way we work with both the nih and the global fund and how we leverage. so we work very closely obviously with nih. they both support scientific development and capacity development in africa with us as well as key research that we need and they thank goodness are working on hiv vaccine and are a meeting this week on that and we're excited about the progress they're making. i think what was missing is the level of absolute working together at the global fund. and over the last 18 months that has really transformed into a almost daily texting. unfortunately for mark, we're in constant communication but in constant communication at every

level in the global fund. >> how did that happen? dr birx: we just committed to it. dr. dybul: well, in part perhaps because i was at pepfar at the beginning and deb was there soon after, and part of it is relationship. parts of it is just an evolution globally and in country. we have no in country presence. we are a financing mechanism, we are leverage mechanism to ensure that people will come together to finance. so, we raise money for the $1.35 you've put in, we spend $4 billion a year on hiv, t.b., malaria and raise from all sectors and i have to say, you know, the senator, the chairman's comments, without that leadership from the u.s., it will unravel. really it's the u.s. that does. when you get to the country level we work as a partnership we bring also the multilateral partners, u.n. institutions, other donors who have incountry expertise to work collectively, the faith community in countries, private sector in countries.

we have forced o's together for impact and get you value for money because we can't achieve it any other way. sen. lankford: right. there's the obvious issues here. i want to keep pressing on this because we deal so much with the finance side. the emergency funding for ebola, $2.7 billion. we sent 3,000 folk to that area to build 11 different ebola centers and if i remember my number correctly, we had 28 people that we ended up treating with $2.7 billion. uncoordinated, too late, massive response, delayed. we can have that in a disease like aids, we can't not have coordination, not have interaction and make sure every dollar's spent wisely. now should we have responded to ebola? yes. did we do it the most efficient

way? i think time will tell us, no, we didn't do it in the most efficient way. so, i want to come back on that again. is there a structure in place -- and i'm proud of the two of you to say it that way that you're working on making sure there's lots of communication -- is there a structure in place to make sure this is ongoing? i hope y'all stay at it and work yourself out of a job soon quite frankly, that would be terrific news. but how's it going building the structure to make sure that's maintained? dr. birx: there's a structure at every level and part of it has to do with leadership and sending that signal down to every level we will work together, not only together in concert at headquarters level and at the implementation level but at the principal recipient level. the global funds money goes through principal recipient. it makes the principal's recipient sometimes nervous how close our dialogue is about what precisely is the global fund doing and what precisely pepfar's doing weep can line that up and marry that information in an absolute clear and transparent way and that's what's new. what the reverend talked about

data and data collection and transparency. that's what will ensure there's not duplication because we know down to the site level where his dollars are going and where our dollars are going. sen. lankford: thank you. keep going on that. y'all are doing great work in raising funds and raising awareness and staying engaged in this. we appreciate and will tonight partner and help in what we can as well. thank you. sen. graham: thank you. excellent line of inquiry we'll follow up on. senator merkley? sen. merkley: thank you, mr. chairman. thank you for your leadership on this issue. this challenge, this world challenge. there's a modest group of leader who had an impact on millions of lives and you're one of those leaders and all of you on the panel you are part of that group. huge thanks to you. i think of others who have been part of the conversation.

paul farmer, who definitely laid out three pandemic in the world, tuberculosis, malaria, aids and that's the biggest leverage we could have. bono, who took paul o'neill over to africa in 2002 to connect on economic development and on the need to address aids. but you're all absolutely a marvelous and sir elton john as you spoke, you spoke in poetic terms, compassion and love and connection and i was really struck and taken to think about the parable the good samaritan the story in which the individual goes on the road from jerusalem to road for three weeks known as the blood road because it was so common for people to be robbed and beaten there. the priest comes by and sees the individual who has been robbed and stripped and beaten and left for dead and keeps going.

and the the same thing. then a samaritan, they were at odds with each other and deeply hostile to each other, it is a samaritan who stopped and helped out. the lawyer questioning jesus says who is your neighbor and that is why he told the story then recognizes the one who reached out and had compassion and got involved when others didn't. you all have done that. thank you so much. the piece of this puzzle that i'd like to ask you to add some additional comments on is this challenge of stigma, back in the 70s, mrs. ford first lady forward proceeded to after her mastectomy to talk about breast cancer and opened the conversation for something that

was hidden and wasn't talked about and explored. in your work, i'm sure you've connected with certain leaders who have changed that dynamic of stigma in different countries and among different groups. can you give us examples of the type of path they have gone down that we should try to find ways to encourage others to follow. sir elton john: it's very important as you stress for people to come out and say like, mrs. ford, had a maskectomy it helped so many women and magic johnson had he had hiv, early on. if somebody comes out, even if they are gay, if they are transgendering, whatever, if people who are out there feeling alone, feeling that they are suffering because they have hiv and gay or any other disease

that they have, when someone else who they identify with comes out and says, listen, i have this and it's ok, it's an incredibly strong thing to do. it's a necessity, not enough people who have hiv who are well known i'm afraid have come out and said i'm hiv positive. that saddens me. it would help so much if more role models and famous people, more sportsman and in africa they love sport and don't -- heroes are sports men. there are many people in the world who are hiv and are famous and too scared to come out and say it. it would help -- the whole thing would be so much easier and that stigma would be lifted if people said i'm living with this disease, i'm not dying with it. look at me, i'm fine. that would help in any circumstance.

you can see with angelina jolie, she said i don't want to have the cancer my mother had. it all helps, people who look up to people. god knows why sometimes but they do and it just especially with aids, it's very, very important for me to say, listen, i'm hiv positive and living with it. you don't have to be ashamed. because it's a sexually oriented disease on the most part, you don't come back from the doctor and say, i've got a terrible cough and stomach ache and don't go to lunch with a friend, i came from the doctor, i have aids. there's nothing -- no reason why you shouldn't. it's because it's talked about and sexually transmitted disease for the most part.

if more people came out and more famous people came out and said hiv is ok, we live with it. i live with it. it's ok. then it would accept -- it would make our situation so much easier. sen. merkley: if we extend that conversation to nations where the conversation is far more impressed -- oppressed or underground than it is here and dr. warren, you had indicated you might have something to add to this and i would love to hear your thoughts. are there spirit you'll leaders and governmental leaders and medical leaders who have taken bold stands and helped change the course of policy and dialogue in countries that we can try to encourage in other places? dr. warren: yeah, whenever i find a pastor who has aids, i tell him, you have to tell everybody, maybe the greatest thing you do with your life. we help people more out of our weakness than our strengths. if i tell you the things i'm good at, goody for you. if i tell you things i'm struggling with, oh, well then maybe god could work in my life too in spite of all of that.

most people know 18 months ago my youngest son who struggled with mental illness for 27 years took his life. it was the worst day of my life. and kay and i decided we would be obviously open about it. i went on cnn and we spent an hour giving testimony to piers morgan on that and it opened a flood gate because you don't help people with your strengths. i used to think that aids was the biggest stigma. i don't anymore, i think mental illness is a bigger stigma. more people are afraid of that. it's not a sin to be sick. your illness is not your identity and chemistry is not your character. when leaders stand up and say i'm struggling with this, a political leader, aids or anything else, it actually allows other people to make progress. we help people more through our weaknesses than our strengths.

sir elton john: can i come back in there? sen. merkley: please. sir elton john: one of the great things in africa in south africa when i went about 12 years ago and i saw women had been -- so many women had been widowed because their husband had died and i was sitting in the hospital and a round table with about 15 people, too men and 30 women and the women were wearing t-shirts saying i have aids and i am proud. and that is the start of a movement where the women in south africa in that area saw it empowering empowering, it's ok. absolutely hit the nail on the head. our weaknesses are our strengths. from a personal point of view i'm terrible at asking for help. i would suffer in silence than say can you help me with this? it's ok to be human and have a failure and have a weakness. he hit the nail right on the head. our weaknesses are our strength. when you empower somebody by saying i'm not as strong as you think i am, it helps a lot.

it really does. sen. merkley: thank you. that example show the power of grass roots action, leaders who helped drive policy or change but citizens together standing up and saying we're changing how this is done. thank you. senator murphy: thank you very much, mr. chairman, what an impressive panel fantastic testimony. let me thank you for raising the issue of mental illness. this is not something we tend to talk about on global tends. we tend to talk about kmunicable diseases but the stigma is not domestic, it's international. the good news here is that on this issue there's a little more bipartisan agreement and myself and senator cassidy and others are working on major rewrite of behavioral health laws but we need to think about this globally as well. senator, an interesting line of testimony and inquiry, one of

the things he talked about was the response to ebola. i don't want people to get the impression that the only thing we did was build a bunch of facilities. we did this because there were going to be a million cases by early this year and we had to be ready for the worst case. we also put a lot of work into our local partners, everything from the right ways to quarantine to the safe practices for those that perish from the disease and it was a lot of that work that made an enormous amount of progress. and so i want to ask about this question of how we work with local governments to improve governance and improve local public health system so we're not just relying on the generosity of the united states and of the church community and of the international community. the reality is that global surveys suggest that one out of every five people in this world have paid in a bribe, actively paid a bribe to get a health service and 40% of people view

their health care system as utterly corrupt. we know where there's survey results are even higher. so how do our public health officials -- and i'll ask dr. dybul this first, how do we make sure our public health dollars are intersecting with the other pots of money we use to improve governance? are we doing that in the right way and with the right level of coordination today? dr. dybul: so i think the most important word -- and thank you, senator, is the last one today. i don't think we were there five or seven years ago. we have a ways to go but the progress has been extraordinary in how we do this. the way the global fund functions, we fund many governments directly and that actually has brought an enormous amount of accountability. i'll never forget the president in rwanda said this is the first time someone held us

accountable. in the past we gave money and measured it on how much money we gave and now it's results. you have to report results down to the site level. we're investing heavily in data and data management systems. it's really hard to steal money if you have to show results. it's much easier to say i did some things. it's drilling down that accountability and data recording down to the site level. we layers and layers of investigative approaches that look at how every dollar is used. and the reality is sometimes it does go in the wrong place. but we find it, collectively and then we bring people to justice, either through the -- and people are actually going to jail for first time for corruption in the health system. in many countries around the world. there's actually really exciting to see -- this is something that these health programs we don't talk about much has driven accountability in a way that really never existed before.

sen. murphy: doctor, let me ask you a different version of that question. we should really care about corruption when our dollars are on the ground. but we should frankly care just as much when our dollars aren't on the ground because we won't need to use as much money if the systems aren't efficiently run. in those cases, who's the right government entity to try to build that capacity? is it our global health dollars or should those be reserved for programs or other pieces of the state department who are more in the business of working with governments at large to make them more accountable and less corrupt? dr. birx: the great thing about what dr. dybul just talked about is how that is integrated at the site of the state department. the u.s. government has ambassadors in each of these countries. being able to get him data that takes the quality of the work at the site, the cost of delivering those services and integrates them in a three-way analysis and

then compares the other sites and partners. you can clearly then see what sites are out of range. what sites are out of range because they are doing more work with less dollars and high quality and which sites are out of range because it's costing more for a low quality product. then we send people in to actually go to the sites and define each of those issue. and then the ambassador takes it forward. we're doing this in partnership with the global fund starting with countries where we share impact in 40 countries. and that same system can be taken into countries where the u.s. government is providing still a third of the dollars through the global fund where there may not be a program. sen. murphy: you were a little optimistic on your ability to work with local governments. that's not always the story we hear. how much does it matter whether you have a local governance structure that is efficient, relatively low on the corruption scale?

i would imagine that you look very carefully at those factors when you're thinking about where to put your dollars and your programming. dr. warren: yes, that's why i go back to this holistic approach to aid and assistance. in the peace plan, promote reconciliation, e is equip ethical leaders because we believe corruption is one of the big five problems in the world along with poverty and disease and illiteracy and conflict. so you have to deal with all of them at the same time. you can't just deal with poverty. you have to deal with corruption. you can't just deal with corruption. you have to deal with education and all of these together. i found in working with local governments around the world most important thing first is just listen, to not assume that i know what i know about the country.

when i go into the country the first thing i do is take a yellow clip board and sit down and listen and listening to their culture and their values and listening to what they are saying. i'm not coming in and automatically imposing something because i want to find out what do you need? there's a verse in the bible that says when you go in the village, find the man of peace that's why we named it the peace plan. the peace person in any culture or corporation -- i found them in nations and found them in businesses and local, you find the man of peace and the peace that they are influential and open to work with you. those are the two characteristics and they don't have to be a christian. when jesus told them to find a man of peace there weren't christians yesterday. he said go find the man of peace. i found men of peace who are muslims and atheists and straight and gay. they are willing to work with you and they are influential. if you find those kind of people, then you start with the

man of peace and you can expand. i think it starts with listening. sen. murphy: i think that's a wonderful way to think about this. one of the points i'm trying to make here, mr. chairman, is that when we look at the money that we spend and the benefit that's acued to global health, we shouldn't just look at the accounts labeled global health. when you are running policeman programs that build men of peace and promote their ability to have influence. whether or not that's a health line item or not, that builds better local health systems. so as we're reviewing the budget at large, just important to pay attention to the fact that sometimes the titles and line items don't necessarily translate there end line benefit. thank you, mr. chairman. sen. graham: thank you all for participating in the hearing. i think each in your own way advanced the cause of protecting this program, which is i'm completely dedicated to because i can see how close we are and

the damage to be done if we back off now. in a news cycle full of bad news most of the time, maybe we'll get five seconds of good news from what you've had to say today. one thing i learned, if we get extra money we'll go in the data collection business and to all of you god bless. you represent the best not only in our country but the best in mankind. you'll have a friend in this committee. this committee stands in recess, we'll keep the record open for questions until the close of business friday, may 15.

[indiscernible] sir elton john: be human, aids is here, no need to push it under the carpet. it can be solved and we should talk about it. >> thank you so much. [indiscernible]

>> can i get a picture? you want to hop in? here we go, ready. >> one more right here. >> one more please, guys. >> thank you so much. >> over here, please. >> thank you very much. >> move a little closer. everybody straight on, right. >> thank you.

[indiscernible]

>> on capitol hill today loretta lynch will testify to congress for the first time is being confirmed as attorney general. she goes before the senate appropriations subcommittee that oversees the justice department budget. the hearing live at 10:30 eastern here on seas and. today, voters in the united kingdom maker your choices for parliament. prime minister david cameron is seeking another term. his main challenger is the labor party leader. the polls close at 10:00 p.m. local time, that's 5:00 p.m. eastern. it will simulcast the election night coverage, which will include extensive interviews for more than 60 locations across the u.k. and political analysis from my tv. it gets underway live at four: 50 5 p.m. eastern. -- 4:55 p.m. eastern. >> sunday night on c-span's

"q&a," kate andersen brower on the white house through the eyes of the people who work there. >> who are the thick lens? >> they are incredible family. my numbers the family have worked at the white house. i interview the only current part-time butler who i didn't get to interview who is still there, he might be the right now, it works every week at the white house. nine members of his family work there. his uncle were major news, like the head butler. he told me that my uncles ran the white house. they brought him in when he was 17 years old in 1959 during the eisenhower demonstration. he is still working there. he described how the use to work in the kitchens, he was a skinny little guy, they kept giving him ice cream deeds. it's incredible that he remembers the eisenhower's.

it's a dying breed of person who remembers that. that's what i wanted to do, to patronage of these people. >> sunday night at 8:00 eastern and pacific on c-span's q&a. loretta limp will -- we will have that hearing live but next "washington journal" is live with your calls and today's news. >> coming up this hour we will look at sentencing and corrections with fred patrick. joining us later lester spence a political science professor at johns hopkins university.

he will discuss racial and socioeconomic factors creating divisions in america's inner cities. plus your facebook comments and tweets and emails. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2015] host: good morning everyone on this thursday, may 7th. loretta lynch will be testifying, talking about the budget for law enforcement agencies. we will have live coverage here on c-span at 10:30 this morning. and discuss the deaths of freddy gray and others and debate about crime and policing. we will begin here